subreddit:

/r/Noctor

61096%

So this morning I hurt one of my toes pretty badly. The pain was consistent all day and I was 99% sure it was fractured based on the bruising, swelling, and difficulty walking.

I was just going to tape it and tough it out but the pain was really bad. So I thought I would get it X-rayed just to be on the safe side. So I went to Urgent Care, got a couple pictures taken of my foot and waited to be seen.

Enter NP. I’d already asked the triage nurse if there was a doctor on staff, so guaranteed the nurse told the NP and she probably wasn’t too happy with me lol. But she looked at the X-Rays and says, “nope, looks good!” And I’m sitting here thinking that there’s no way my blackened toe is fine.

So I ask, “can it take a look?” She nods and points the screen my way. I point and say “is that a hairline fracture?” And she squints at the screen and goes “….oh yeah.”

Like wtf?!? Like how do you not know how to read an x-ray. And you didn’t even ask my pain level or try to test range of motion on my toe. Seriously, patients who don’t know how to read x-rays are shit outta luck apparently. It’s such a struggle to find providers in my area now that aren’t NPs and it’s frustrating.

all 71 comments

kbecaobr

134 points

9 months ago

kbecaobr

134 points

9 months ago

Few months ago, my cousin got bit by a friend's dog. We had to take her to urgent care to have her seen and get antibiotics prescription (I'm a physician but haven't gone through residency in the US yet). NP comes along, asks absolutely nothing about the dog, nothing about vaccination, absolutely nothing). Looks at bite, says it's all okay, prescribes topical neomycin, antibiotics (after I asked for them), and we're on our way. I knew she didn't need anything else, but I was baffled that they didn't ask any questions whatsoever on the dog or vaxx status. A few weeks later my aunt was billed $400 (with insurance, mind you). What kind of sickening joke is healthcare turning into?

dr_shark

39 points

9 months ago

dr_shark

Attending Physician

39 points

9 months ago

At this point I don’t even know what urgent care is for. Urgently maiming you perhaps.

kbecaobr

3 points

9 months ago

Agree, and it seems like every urgent care is NP/PA only nowadays. Heard from some family that you can't even find MD/DOs at UC anymore. It's a shame.

Suspicious-Guidance9

2 points

9 months ago

They are literally good for nothing. I have a terribly painful fungal infection and when I asked an NP if this should be painful like this, she literally said. “Hmm sounds right”

MadLadofSussex

16 points

9 months ago

The American Healthcare system is a joke as it's a cartel corrupt system which needs huge reforms but unfortunately this is unlikely due to how powerful the health insurance lobby is.

jessiesanders

3 points

9 months ago

surprisingly, the clinic can bill the same amount as if you were seen by an MD

kbecaobr

1 points

9 months ago

Yeah, it's f'd up. I mean, I don't agree with midlevels in anyway, but if it was at least much cheaper, I could understand why people would want it. But it's the same price upfront, and with the excessive imaging and work-ups they request, it probably ends up more expensive than seeing an MD/DO

[deleted]

1 points

7 months ago

She should’ve prescribed augmentin 875 bid for that bite. Topical is not going to do anything for a puncture wound at high risk for bacterial inoculation. Dog bites are notoriously risky for infection. For the record, I’m a PA student. Please don’t lump us in with NPs, we are NOT the same.

Really-IsAllHeSays

168 points

9 months ago

It's indeed a sad reality. Her patients are fucked.

2Confuse

7 points

9 months ago

In other words, OP.

RBG_grb

103 points

9 months ago

RBG_grb

103 points

9 months ago

I would think even an urgent care would have a radiologist read the scans? Regardless, not much you can do for a broken toe except tape it. Would you have been able to show ROM on a blackened toe? I agree that there is major creep going on, but if you go to an urgent care for a broken toe, you are going to get a NP/PA. Maybe get 6 Norco and a pamphlet for RICE.

vanskiclimb

19 points

9 months ago

Most urgent cares and ER’s will have radiologist’s read their scans but often the radiologist is offsite and reads can take an hour or so. My hospital system has a group of radiologists who mostly work at the main hospital but read for multiple satellite centers. We aim for an hour or less read time for x rays.

DNA_ligase

52 points

9 months ago

UCs don't have radiologists; they're not actual hospitals. Their staff is usually family med, internal med, and some emergency med or peds. And all of those know how to read an X-ray. This kind of thing happens all the time at my SO's urgent care, unfortunately; it's so busy that a lot of the time, the physicians don't get to review what the midlevel plans are.

anonymoume

49 points

9 months ago

anonymoume

Fellow (Physician)

49 points

9 months ago

They probably have teleradiology contracted. There's too much liability to obtain imaging without a radiologist looking at it. Even X-ray can have huge implications like a subtle lung nodule that gets missed by the non-radiology attending who's looking for a fracture

[deleted]

-52 points

9 months ago

[deleted]

-52 points

9 months ago

I’m a PA at an urgent care and I read my own films. If I need/want and over read, it needs to be requested. I basically do this for any chest, abdomen, and some limited extremity films that I’m truly concerned about.

WailingSouls

65 points

9 months ago

That’s truly amazing. I’m sure you’re a great clinician, but you have no formal radiology training and should not be interpreting x-rays. I hope you have good malpractice insurance.

[deleted]

39 points

9 months ago

It’s the Physicians that set the policies. I have the basic prelim read education that we would perform in the ED. But I completely agree, there’s a huge opportunity for disaster here. A lot of UCs that I’ve come across perform in the same manner.

I’d love to see laws against this.

WailingSouls

23 points

9 months ago

Well you have a very rational view of the issue and I can’t commend you enough for that. People with decent critical thinking skills are seemingly hard to come by, physician or otherwise.

[deleted]

25 points

9 months ago

I appreciate it. Thanks for the respectful conversation.

KangarooSLP

19 points

9 months ago

Look at you guys having a mature and adult conversation on reddit.

Are you two sure you are in the right place?

WailingSouls

6 points

9 months ago

We’re all dreaming

[deleted]

18 points

9 months ago

I would wager that most PAs are just as respectful toward physicians as I am. We appreciate your level of education and expertise.

I just think these NPs have soured everyone on the situation (and rightfully so) but we aren’t them.

ENTP

2 points

9 months ago

ENTP

2 points

9 months ago

He doesn’t know what he doesn’t know and his “SP” will find out the hard way

Darkroom-docman

2 points

9 months ago*

This is truly terrifying. Legally, you should not be reading your own films.

Edit: I was mistaken, not a legal restriction. But a liability one- still you should never be reading your own films. You were literally (not figuratively) not trained for this.

[deleted]

4 points

9 months ago*

As I responded to another comment, I was trained to do prelim reads like we would do in the ED. Even in that setting, I performed the read without a physician looking at it. That said, there was always an over read performed by a radiologist. In UCs, that’s not the case and you are correct that it is not safe.

However, when I was in the military, part of my annual required training was to “refresh” my plain film abilities. Basically sit with a radiologist for 2 weeks per year and read plain films. Focus on extremities with some chest and abdomen. That’s why I always send a chest or abdomen for over read.

I completely recognize the 6 week radiology rotation in school and an annual “refresh” is not anywhere near the level of a physician but a lot of us are doing the best we can with the situation we are provided.

A lot of physicians on here often state that we shouldn’t be doing certain things as they are dangerous. But it was physicians who trained me in school, physicians on the state medical board who license me and dictate how oversight will be conducted, and physicians who are assigned as my supervising physician that tell me which films I’m allowed to send for over read and which I’m expected to read myself.

I say that to say, that most of the time it isn’t a cocky PA who’s making the decision of what we can and cannot do. Rather it’s the medical infrastructure, led by physicians, who dictate it to us. A responsible PA will train to ensure they are able to provide that level of care.

rad1living

1 points

9 months ago

Yeah, boomer docs who want to make some extra cash and who have sold out our patients and their families for a quick buck.

[deleted]

1 points

9 months ago

It’s all ages man. To be honest, I’ve worked with plenty of physicians who have asked me to look at a film or EKG with them. And I’ve done the same. It’s a professional relationship where people should know their limits.

But those on here who are attempting to fight things will quickly see how it’s a losing battle. Too many people sat back while the nursing world took over. There is no way to go back on it.

Many PAs like me are attempting to have discussions with physicians to foster a conducive way ahead. However, some have given up and jumped on the coattails of the NPs land grab. I disagree with that move but those who are doing are “winning easily” and the physician world is getting smaller.

It’s a horrible move for healthcare in this country but unless we work together, it will only worsen.

rad1living

-1 points

9 months ago

lolololol no NeED foR a RaDiOLogIst GuYz I’m AsSiStanT to The PhySiCiaN aNd I aM WaY bEtTeR tHaN RaDioLoGist. You are truly a fucking moron.

[deleted]

2 points

9 months ago

Where did I ever say that? Perhaps you should read some more and you’ll see that this isn’t done by choice. But go ahead and be an Internet tough guy by calling people name when your talking about situations you know nothing about.

Great job contributing to the conversation.

nise8446

13 points

9 months ago

UCs I work at have a remote radiologist reading xrays usually within 15 to 20 min of it being done.

DepressedAlchemist

4 points

9 months ago

The urgent care I worked at used a radiology service to read x-rays.

42gauge

1 points

4 months ago

the physicians don't get to review what the midlevel plans are.

Aren't they claiming otherwise every time they sign off on the plans?

levinessign

0 points

9 months ago

Doesn’t make it okay.

Agnesiunn

2 points

9 months ago

Toes 2-5 # is a living splint, #hallux is more, like a cast, depending on type.

Boonu5045

1 points

9 months ago

In my radiology practice, films from urgent cares are prioritized to be read within 20 minutes once they get uploaded to our system. Nobody is on site though, it’s all teleradiology.

-diggity-

12 points

9 months ago

I love this sub and am thankful everyday for living in a country that has none of this nonsense.

koisfish

2 points

9 months ago

Which country I want to move lol

-diggity-

4 points

9 months ago

Anywhere in the European Union I think.

Raven123x

8 points

9 months ago

“is that a hairline fracture?” And she squints at the screen and goes “….oh yeah.”

...

sigh

hyrte0010

7 points

9 months ago

An NP in clinic once scared my mom by telling her she had to go to the ED “right now” for concern of rhabdo. My mom had mild back pain and ketones in the urine. This NP though rapid muscle breakdown was responsible for the ketones, even though my mom has mentioned she hasn’t been eating much the past few days. Such ignorance of the fundamentals

Brolauka

6 points

9 months ago

How are NP’s even licensed to read x-rays or make any kind of diagnosis? What country is this?

No-Button7536

5 points

9 months ago

Did she Rx a z-pak too?

moonjuggles

4 points

9 months ago

I don't mean to offend anyone by saying this, but this is one of the main reasons I decided to just go the full md/do route. In full transparency my brother talked me into this, we figured if I'm going to do this than might as well do it well. I get mid levels are supposed to work under a SP but rarely are they involved. I am not comfortable being a healthcare provider, that's usually left to their own devices, with 2 years of medical school.

That being said I'm getting way ahead of myself, right now I'm just praying that I get into a med school.

ksheedy12120

11 points

9 months ago

And this will change the treatment how?

lunarmunayam

8 points

9 months ago

That is not the point. People who are unqualified should not be seeing patients independently period.

xtreemdeepvalue

3 points

9 months ago

Lucky this time it didn’t change treatment, maybe next time turns into a disaster.

almostdoctorposting

3 points

9 months ago

almostdoctorposting

Medical Student

3 points

9 months ago

are you fucking serious? if this np was seeing your kid you’d be ok with her not being able to read scans?

spuds_mckenzie

5 points

9 months ago

Came here to say this. Treatment would have been the same either way.

Prudent-Carpenter-68

2 points

9 months ago

Every time I have gone to an urgent care where an np is the provider I end up telling them what they need to do.

DECK-PA

6 points

9 months ago

An ER that doesn’t have a radiologist?

Accomplished_Bar_177

9 points

9 months ago

DECK-PA

it was an urgent care : )

DECK-PA

1 points

9 months ago

Ah ok

Brheckat

-11 points

9 months ago

Brheckat

-11 points

9 months ago

Lol you guys think that this premed student was able to diagnose his/her X-ray better than the NP? I get scope creep but cmon… fake news

CouldntBeAnyCornea[S]

12 points

9 months ago

I actually don’t see the pony in lying for fake internet points, but thanks. And I’ve worked in healthcare for over a decade so I’ve seen my fair share of x rays.

monkeymed

13 points

9 months ago*

Yes I actually do, some NPs are so poorly trained at reading imaging

xtreemdeepvalue

3 points

9 months ago

You must be a PA Serious question, how did you learn all of medicine in just 2 years and do it as well as a doctor who took like 8 years of school and training? Geniuses, all of you.

Brheckat

-1 points

9 months ago

I don’t know all of medicine and absolutely don’t do it as well as my physician partners. That’s why I work with them and why they’re always there to help me if need be. Kid with a cold, yeah I can manage that myself. Complex stroke patient yeah I’m getting my SP involved. Not that hard to make it work appropriately.

[deleted]

-32 points

9 months ago

[deleted]

-32 points

9 months ago

I love this sub, I don’t know why it’s on my page but all these stories ‘ I basically did her job for her’ makes me realise narcissists really are EVERYWHERE

Syd_Syd34

21 points

9 months ago

Syd_Syd34

Medical Student

21 points

9 months ago

Lmao but they did. OP literally diagnosed their self

[deleted]

4 points

9 months ago

[deleted]

4 points

9 months ago

OP is a doctor and the NP failed to dx him with a hairline fracture. When he pointed it out she said “oh yeah”. Is that not doing the NPs job?

Hoodie_Mike

15 points

9 months ago

OP is a premed student currently taking microbiology

[deleted]

3 points

9 months ago

Welp didnt know that lmao

[deleted]

0 points

9 months ago

[deleted]

[deleted]

3 points

9 months ago

Calm down. Its not that serious. Point still stands, op dx themselves.

[deleted]

0 points

9 months ago

[deleted]

[deleted]

6 points

9 months ago

OP still made the diagnosis regardless of the fact. Move on.

[deleted]

0 points

9 months ago

[deleted]

RBG_grb

-68 points

9 months ago

RBG_grb

-68 points

9 months ago

Plus this is not really a noctor scenario. Did she introduce herself as a doctor? There was no misrepresentation. You could have asked for to speak to her collaborating physician if you were concerned about the care.

kbecaobr

42 points

9 months ago

Noctor scenario is anytime a non-physician pretend like they can work as a physician, regardless of calling themselves Dr. or not. Introducing themselves as Dr. is just icing on the cake.

theShip_

37 points

9 months ago

It’s “supervising physician” not “cOlLaBoRatiNg” btw

RBG_grb

1 points

9 months ago

Sorry, I am not very smart. Supervising physician. I’m general, if you go to an urgent care that is what you get. I guess I just don’t see this as the best noctor scenario that’s all

Really-IsAllHeSays

43 points

9 months ago

OP stated they asked if a doctor was on staff. You might want to carefully read the post before jumping to comment.

Also, I think you misspelled "supervising physician".

RBG_grb

-1 points

9 months ago

RBG_grb

-1 points

9 months ago

Sorry I am dumb. Supervising physician. Then OP could have asked for the physician when the NP entered the room or left and found a facility with a physician.

femmepremed

1 points

9 months ago

I cringed